Abstract
Objective: Treatment of ruptured blood blister-like aneurysms (BBAs) of the internal carotid artery remains challenging due to the fragility of the aneurysm membrane structure. Here, we report long-term results of ruptured BBAs treated with endovascular coil embolization using a vascular reconstruction stent.
Methods: Four ruptured BBAs in four consecutive patients (one male and three females; mean age, 46 years; age range, 41-50 years) were treated with assisted endovascular coil embolization using a vascular reconstruction stent between September 2013 and February 2017. Treatment results and longterm angiographic and clinical outcomes were retrospectively analyzed.
Results: All four BBAs were treated with stent-assisted coil embolization. Two of the patients underwent a single-stent insertion using the jail and trans-cell technique with a coil, and the rest two underwent a double-overlap stent insertion using the stent in a stent technique. Both patients who underwent overlapping stent placement presented excellent outcomes (modified Rankin Scale, 0) with complete angiographic obliteration of the BBAs. One patient who underwent single-stent placement experienced aneurysm regrowth with and without rebleeding. The recurrent BBA was treated twice with additional coil embolization. No treatment-related complications developed in any of the patients. All four surviving patients exhibited excellent outcomes during the clinical long-term follow-up period (mean, 3.5 years; range, 2-5 years). Complete BBA obliteration and smooth reconstruction of the affected segment of the internal carotid artery were achieved on long-term follow-up angiography during the same period.
Conclusions: Stent overlapping in the ruptured BBA treatment with stent-assisted coil embolization for long-term stabilization to secure the parent artery is important.
